Evidence for Negative Effects of Elevated Intra‐Abdominal Pressure on Pulmonary Mechanics and Oxidative Stress

Abstract

Objective. To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2), arterial blood gases (ABG), and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF) during laparoscopic cholecystectomy (LC) by using lung-protective ventilation strategy. Materials and Methods. Forty-six patients undergoing LC and abdominal wall hernia (AWH) surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery. Results. Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS), arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group. Conclusions. Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.

Comment on “Evidence for Negative Effects of Elevated Intra‐Abdominal Pressure on Pulmonary Mechanics and Oxidative Stress”

“…Findings of these studies supporting correlations of changes in arterial blood gases with the end-tidal CO 2 concentration, as well as ventilation parameters and dynamic lung compliance [ 1 – 3 ], were in accordance with results by Strang et al [ 9 ] concerning arterial pCO 2 to end-tidal CO 2 gradient, which is strongly correlated with the amount of atelectasis estimated by an end-expiratory transversal spiral computed tomography with subsequent calculation of the total lung volume with further analysis of the lung tissue density as normally, poorly, over-, and nonaerated (atelectasis) regions.…”

“…We read with great interest the recently published article by Davarcı et al [ 1 ] in your journal aimed at studying the effects of CO 2 -pneumoperitoneum at 12 mm Hg intraperitoneal pressure on end-tidal CO 2 (P ET CO 2 ) concentration, arterial blood gas values and oxidative stress markers in blood, and bronchial lavage during laparoscopic cholecystectomy using a long protective strategy since our clinical [ 2 ] and experimental [ 3 ] results were in line with findings of this study [ 1 ]. The authors clearly demonstrated significant changes of the peak in respiratory pressure, dynamic lung compliance, P ET CO 2 , arterial pO 2 , pCO 2 , and pH values at the 30th min of CO 2 -pneumoperitoneum in comparison with parameters of both at the baseline and at the end of surgery.…”

“…These changes we considered as consequences of a causative force of CO 2 -insufflation with increased content of CO 2 in the body (rise of P ET CO 2 and arterial pCO 2 ), with subsequent mild respiratory or severe acidosis (reduced pH) depending on intraperitoneal pressure rate and CO 2 -pneumoperitoneum duration [ 4 – 6 ]. Subsequently, the dynamic lung compliance was reduced with increased peak of respiratory pressure in adult patients with ASA I/II [ 1 ].…”

“…Results of these studies [ 1 – 3 ] clearly demonstrated negative effects of elevated intraperitoneal pressure on parameters of blood gases, acid base, and oxygen homeostasis as well as respiratory and cardiovascular systems during laparoscopic procedures. Obviously, these changes were pronounced in newborns in relatively lower intraperitoneal pressure (7–9 mm Hg).…”

Ligation-free technique for dorsal vascular complex control during laparoscopic radical prostatectomy: a single-center experience from China

“…To avoid carbon dioxide intoxication, we normally did not raise the pneumoperitoneum pressure. We believe that will burden a relative risk of cardiopulmonary function on patients, which could also influence the postoperative recovery [5,6]. Finally, a running vesicourethral anastomosis is achieved by using a 2 X T4 taper, 14 cm × 14 cm, double-armed barbed suture (Quill™ SRS, Angiotech, Reading, PA) and the Van Velthoven technique [7].…”